This article is more than 5 years old. Information may no longer be current.
Piperacillin-tazobactam ‘particularly damaging’ to gut microbiota
Click Here to Manage Email Alerts
Piperacillin-tazobactam is “particularly damaging” to human gut microbiota and its use is associated with a low abundance of potentially protective bacteria, including those that might defend against Clostridium difficile and multidrug-resistant organisms, according to findings from a study of ICU patients.
Writing in Clinical Infectious Diseases, Melinda M. Pettigrew, PhD, senior associate dean of academic affairs and professor of epidemiology at Yale School of Public Health, and colleagues said there are limited data available to clinicians on the selection of antibiotics to minimize microbiota disruptions in the human gut.
Their study included ICU patients with or without Pseudomonas aeruginosa, an important health care-associated infection that is often resistant to antibiotics and “readily colonizes” the gastrointestinal tract of hospitalized patients, Pettigrew and colleagues noted. According to their study, approximately 28% of ICU patients colonized with carbapenem-resistant P. aeruginosa (CRPA) develop infections from the colonizing strain.
“Thus, prevention of CRPA colonization-acquisition represents an important target for interventions to reduce infection and spread of CRPA in the hospital,” Pettigrew and colleagues wrote. “We reasoned that greater understanding of relationships between the microbiota, medications, and CRPA colonization-acquisition would help inform the selection of antibiotics that minimize microbiota disruption and advance development of tools for patient monitoring for risk of CRPA colonization and infection. Thus, our study goals were to 1) describe the GI microbiota of ICU patients, 2) examine the impact of antibiotics and other medications on the GI microbiota, and 3) identify taxonomic markers associated with CRPA colonization-acquisition in the GI tract.”
The researchers collected data and perirectal swabs from 109 patients admitted to either the medical ICU or surgical ICU at the University of Maryland Medical Center — a tertiary-care hospital in Baltimore. Patients were categorized into three groups based on their CRPA colonization-acquisition status and antimicrobial exposures, according to the study. Swabs were taken on admission to the ICU and one or more additional swabs were also taken. Pettigrew and colleagues sequenced the samples to evaluate the associations between patient characteristics, medications, GI microbiota and CRPA colonization-acquisition, according to the study.
They reported that patients with CRPA colonization-acquisition were more frequently prescribed piperacillin-tazobactam than patients without colonization. Use of piperacillin-tazobactam was associated with a low abundance of potentially protective taxa, including Lactobacillus, which is higher in patients without multidrug-resistant infections, and Blautia, which may protect against C. difficile.
Additionally, the combination was associated with an increased risk for Enterococcus domination (OR = 5.50; 95% CI, 2.03-14.92).
“Our data suggest that piperacillin-tazobactam contributes to microbiota disruption and indicate that low relative abundances of specific taxa may be related to risk of CRPA colonization-acquisition,” Pettigrew and colleagues wrote. “When possible, antimicrobial therapy should be tailored based on colonization status and/or when infection is suspected in CRPA-colonized patients. Experimental studies are needed to determine which commensals are causally related to colonization resistance.
“Greater understanding of these relationships will facilitate the development microbiota disruption indices that could be used for monitoring patients for risk of CRPA colonization and infection, and the development of strategies to minimize infection and spread of CRPA in the hospital.” – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.
Click Here to Manage Email Alerts